Extra-axial central nervous system lesions- a clinicopathological overview
Abstract
Background: Extra-axial Central Nervous System (CNS) lesions simply abut the CNS from meningeal or juxtameningeal site and include lesions arising from extra-parenchymal elements in CNS including meninges, nerve sheath or midline neur-axial structures confining to sellar region, pineal region and ventricles.
Objective: To study extra-axial CNS lesions in terms of frequency, demography, topography and to assess utility of squash cytology to for their rapid diagnosis.
Material and Methods: Total 383 cases of all clinically and radiologically suspected and/or histopathologically confirmed cases of extra-axial CNS lesions were studied with above mentioned objectives and resuls were tabulated and analysed.
Result: Extra-axial lesions contributed 49.10% cases of all CNS lesions. Of these extra-axial lesions 68% were neoplastic (benign & malignant) and most of these (86.9%) neoplasms were benign. Neoplastic lesions were most commonly seen in 4th -5th decade while non-neoplastic in 1st-3rd decade with equal sex distribution. They were commonly located intracranially (73.36%) than at spinal location. Meninges were most common affected site. Intracranially meningioma (37.09%) and epidermoid cyst (46.38%) were most common neoplastic and non-neoplastic lesions respectively. While schwannoma (39.59%) and tuberculosis (45.28%) were most common neoplastic and non-neoplastic lesion at spinal location respectively. Extra-axial metastatic neoplasms contributed 2.08% of extra-axial CNS lesions. Developmental anomalies were seen in 19.5% cases. 7.28% neoplastic lesions were recurrent of which maximum were pituitary adenomas. In 74.41% cases radiological diagnosis matched exactly with histopathological diagnosis while squash cytology provided exact diagnosis in 89.84% cases.
Conclusion: Extra-axial CNS lesions are common, constituting nearly half of the cases of CNS lesions; most of which are intracranial, slow growing, benign neoplasms and squash cytology plays a great role in intra-operative consultation.
Downloads
References
2. Zimny A, Sasiadek M. Contribution of perfusion-weighted magnetic resonance imaging in the differentiation of meningiomas and other extra-axial tumors: case reports and literature review. Journal of Neuro-Oncology. 2011;103(3):777-783.
3. Mustafa Kemal Demir, ÖzlemYapıcıer, ElifOnat et al. Rare and challenging extra-axial brain lesions: CT and MRI findings with clinico-radiological differential diagnosis and pathological correlation. DiagnIntervRadiol. 2014 Sep-Oct; 20(5): 448–452.doi: 10.5152/dir.2014.14031
4. Soonmee Cha, Edmond A. Knopp, Glyn Johnson, Stephan G. Wetzel, Dr med Andrew W. Litt, David Zagzag. Intracranial Mass Lesions:Dynamic Contrast-enhanced Susceptibility-weighted Echo-planar Perfusion MR Imaging. Radiology. 2002;223:11–29.doi/pdf/10.1148/radiol.2231010594
5. Extraaxial Brain Tumors. National Institute of Neurological Disorders and Stroke (NINDS) [Updated on: 3 Feb 2014] Available from: http://www.ninds.nih.gov/about_ninds/groups/brain_tumor_prg/Extraaxial.htm
6. TamkeenMasoodi, Ram Kumar Gupta, J. P. Singh, ArvindKhajuria. Pattern Of Central Nervous System Neoplasms: A Study Of 106 Cases. JK-Practitioner. 2012;17(4): 42-46.
7. Intisar S H Patty. Central Nervous System Tumors A Clinicopathological Study. J Dohuk Univ. 2008;11(1):173-180.
8. Anne G. Osborn. Extra-Axial Neoplasms, Cysts and Tumor-Like Lesions, In: Professor Nicholas C. Gourtsoyiannis, Pablo R. Ros, eds. Radiologic-Pathologic Correlations from Head to Toe. Berlin Heidelberg. Springer. 2005. p. 27-33.
9. Engelhard HH, Villano JL, Porter KR, Stewart AK, Baura M, Barker FG et al. Clinical presentation, histology and treatment in 430 patients with primary tumours of the spinal cord, spinal meninges or caudaequina. J Neurosurg Spine. 2010 Jul;13(1):67-77.doi: 10.3171/2010.3
10. Hufana V, Tan JS, Tan KK. Microsurgical treatment for spinal tumours. Singapore Med J. 2005;46(2):74-77.
11. Zalata KR, ElTantawy DA, AbdelAziz A, Ibraheim AW, Halaka AH, Gawish HH, Safwat M, Mansour N, Mansour M, Shebl A et al. Frequency of central nervous system tumors in delta region, Egypt. Indian J Pathol Microbiol. 2011;54(2):299306.
12. DukkipatiKalyani, S. Rajyalakshmi, O. Sravan Kumar et al. Clinicopathological study of posterior fossa intracranial lesions. J Med Allied Sci. 2014;4(2):62-68.
13. Celli P, Trillo G, Ferrante L: Spinal extradural schwannoma. J Neurosurg Spine. 2005;2:447-456.
14. Jeon JH, Hwang HS, Jeong JH, Park SH, Moon JG, Kim GH. Spinal schwannoma : analysis of 40 cases. J Korean Neurosurg Soc. 2008;43:135-138.
15. Seppala MT, Haltia MJ, Sankila RJ, Jaaskelainen JE, Heiskanen O. Long term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases. J Neurosurg. 1995 Oct;83:621-626.
16. Konovalov AN, Pitskhelauri DI. Principles of treatment of the pineal region tumors. Surg Neurol. 2003;59:250-268.
17. Regis J, Bouillot P, Rouby V, FigarellaB,Dufour H, Peragut JC. Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery. 1996;39:907-912.
18. Katzman GL. Epidermoid cyst, In: Diagnostic imaging: brain. Salt Lake City, Utah. Amirsys. 2004. p.7-16.
19. Roux A, Mercier C, Larbrisseau A et al. Intramedullary epidermoid cysts of the spinal cord. J Neurosurg. 1992;76(3):528-533.
20. Sundaram C, Paul T R, Raju B V, Ramakrishna Murthy T, Sinha A K, Prasad V S, Purohit A K. Cysts of the central nervous system : a clinicopathologic study of 145 cases. Neurol India. 2001;49:237.
21. Traul DE, Shaffrey ME, Schiff D. Spinal cord neoplasms- intradural neoplasms. Lancet oncol. 2007 Jan;8(1):35-45.
22. Guidetti B, Gagliardi FM. Epidermoid and dermoid cysts. Clinical evaluation and late surgical results. J Neurosurg 1977;47:12-18.
23. Fortuna A, Mercuri S. Intradural spinal cysts. ActaNeurochir (Wien). 1983(3-4);68:289-314.
24. Odebode, Udoffa U, Nzeh D. Cervical myelomeningocele and hydrocephalus without neurological deficit: A case report. American-Eurasial Journal of Scientific Research. 2007;2(1):60-62.
25. Shah AB, Muzumdar GA, Chitale AR, Bhagwati SN. Squash preparation and frozen section in intraoperative diagnosis of central nervous system tumors. Acta Cytol.1998;42(5):1149–54.
26. Chacko G, Chandi SM, Chandi MJ. Smear diagnosis of central nervous system lesions: a critical appraisal. Neurol India 1998;46:115–8.
27. Firlik KS, Martinez AJ, Lunsford LD. Use of cytological preparations for the intraoperative diagnosis of stereotactically obtained brain biopsies: a 19-year experience and survey of neuropathologists. J Neurosurg 1999;91:454–8.
28. Bleggi-Torres LF, de Noronha L, Schneider Gugelmin E et al. Accuracy of the smear technique in the cytological diagnosis of 650 lesions of the central nervous system. DiagnCytopathol 2001;24:293–95.
29. Goel D, Sundaram C, Paul TR et al. Intraoperative cytology (squash smear) in neurosurgical practice –pitfalls in diagnosis experience based on 3057 samples from a single institution. Cytopathology 2007;18:300–8.
30. Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15-year experience based on 4,172 patients. Acta Cytol 2002;46(4):667-74.
OAI - Open Archives Initiative
